- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,251.00 / $11,627.00
| Facility | | $1,258.93 | $6,251.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $6,462.00 / $25,522.00
| Facility | | $2,291.00 | $6,462.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.17 / $830.60 / $1,028.05
| Facility | | $692.17 | $830.60 | $1,028.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $8,796.00 / $13,382.00
| Facility | | $4,227.00 | $8,796.00 | $13,382.00 |